Core to Discipline

Key Features
- This EPA focuses on applying neonatal resuscitation guidelines, as relevant, and working effectively with the resuscitation team.
- This includes high-risk deliveries.
- This includes providing stabilization and arranging transfer to the NICU, as relevant.
Assessment Plan
- Direct observation, case presentation or review of written documentation by supervisor, senior resident, nurse practitioner, or advanced care nurse
Collect 3 observations of achievement
- At least 2 observers
Key Features
- This EPA focuses on the resuscitation and stabilization of critically ill pediatric patients of all ages.
- This EPA includes identifying priorities for management and the need for intensivist and/or other specialist support.
- It includes participating in a debrief session after the acute event.
- This EPA does not include ongoing inpatient management of acutely ill pediatric patients.
- This EPA may be observed in the simulation setting.
Assessment Plan
- Direct observation by supervisor
Collect 5 observations of achievement
- At least 1 neonate
- At least 1 infant/preschool
- At least 1 school aged
- At least 1 adolescent
- No more than 1 in simulation setting
- At least 1 of each presentation
Key Features
- This EPA builds on the skills achieved in the Foundations stage to focus on obtaining a history and completing a physical exam for patients with undifferentiated, complex single system or multiple active competing conditions at varying levels of chronicity.
- This includes patients with medical and/or psychosocial issues who may be unstable and/or uncooperative.
- It includes developing a prioritized problem list with a differential diagnosis.
- This EPA does not include ongoing management of the patient.
Assessment Plan
- Direct observation or case review by supervisor
Collect 4 observations of achievement
- At least 2 direct observations
- No more than 1 in a neonate
- At least 3 different types of conditions
- No more than 2 assessments with the same type of condition
- At least 2 different assessors
Key Features
- This EPA focuses on assessing, diagnosing and providing management for patients with an acute presentation.
- This includes patients with a new presentation, as well as patients with acute exacerbations or decompensations of a chronic disorder and/or complications of treatment or the condition.
- It also includes arranging for inpatient, emergency, or outpatient follow-up.
- This EPA does not include resuscitation of critically ill or injured patients.
Assessment Plan
- Direct observation or case review by supervisor, TTP or subspecialty resident, clinical associate or nurse practitioner
Collect 8 observations of achievement
- At least 6 direct observations
- At least 2 of each age group: neonate; infant/preschool; school aged; adolescent
- No more than 2 observations with the same type of condition as the primary presenting medical problem
- At least 6 observed by supervisor
- At least 3 different assessors
Key Features
- This EPA focuses on providing ongoing comprehensive management that includes implementing screening, surveillance, or monitoring strategies, assessing medication adherence and effects, as well as addressing patient and family concerns, and providing education and appropriate follow-up.
- It includes identifying patients with a fluctuating clinical course, recognizing the need for change or escalation of therapy, and implementing a therapeutic plan.
- This EPA may include patients whose condition is complex, and therefore requires a consideration of the patient’s treatment goals, interactions between different diseases and treatments, consideration of multimorbidity and frailty and, often, coordination with other physicians and health care professionals.
- This EPA includes providing anticipatory guidance to the patient and family in the primary care role for overall health maintenance and/or surveillance, and advocating for the patient’s health care needs.
- This may include the management of patients who are technology dependent.
Assessment Plan
- Direct observation or case review by supervisor
Collect 8 observations of achievement
- At least 3 direct observations
- At least 8 different conditions
- At least 1 community setting
- At least 5 different observers
Key Features
- This EPA focuses on the recognition, assessment, and management of mental health issues.
- Examples include patients with ADHD; anxiety disorder; conversion disorder; early psychosis; eating disorders; mood disorders; obsessive compulsive disorder; oppositional/disruptive and conduct disorders; substance abuse disorders, including tobacco/nicotine products; and suicidal ideation, intent, and attempts.
Assessment Plan
- Direct observation or case review by supervisor
Collect 5 observations of achievement
- At least 2 by direct observation
- At least 5 different conditions
- At least 1 in longitudinal clinic
- At least 2 in the community
- At least 3 different observers
Key Features
- This EPA focuses on the recognition, assessment, and management of behavioural, developmental, and school issues.
- Examples include patients with autism spectrum disorder, common behaviour problems, isolated and global learning difficulties, isolated and global developmental disorders, and sleep hygiene issues and sleep disorders.
Assessment Plan
- Direct observation or case review by supervisor
Collect 5 observations of achievement
- At least 2 by direct observation
- At least 4 different conditions
- At least 2 in longitudinal clinic
- At least 2 in the community
- At least 3 different observers
Key Features
- This EPA focuses on recognizing and managing patients who have experienced physical, emotional, and/or sexual maltreatment or neglect, or in whom it is suspected.
- It also includes recognizing when a patient is at risk, when there may be a detrimental imbalance between care needs and care provided, or when police and/or social services need to be engaged.
- This EPA does not include preparing legal reports or testifying in court about alleged child abuse and/or neglect.
Assessment Plan
- Direct observation by supervisor
Collect 3 observations of achievement
- At least 1 physical maltreatment (including suspected)
- At least 1 sexual maltreatment (including suspected)
- At least 1 neglect (including suspected)
Key Features
- This EPA includes determining which procedures are necessary and appropriate to
  the situation.
- Procedures include: accessing port-a-cath; cardiopulmonary resuscitation (defibrillation); chest tube; ear curettage; G-tube reinsertion; immunization (intramuscular); immunization (subcutaneous); intubation; IV insertion; lumbar puncture with/without injection in preschool/school age child; managing occlusion in long-term access line; nasogastric tube; nasopharyngeal swab; obtaining an EKG; phlebotomy; surfactant administration; throat swab; umbilical arterial line; umbilical venous line; urinary catheterization.
- Some procedures may be observed in a simulation setting, including Pediatric Advanced Life Support (PALS) or Neonatal Resuscitation Program (NRP) and/or mock codes.
- This EPA does not include other commonly performed procedures that are present in the other stages of training (Foundations).
Assessment Plan
- Direct observation by supervisor
Collect 33 observations of achievement (those marked with an asterisk may be observed in simulation)
- At least 1 access port-a-cath*
- At least 1 cardiopulmonary resuscitation (defibrillation)*
- At least 2 chest tubes*
- At least 2 ear curettage
- At least 1 G-tube reinsertion*
- At least 2 immunizations (intramuscular and subcutaneous)*
- At least 3 intubations in neonates/infants
- At least 2 IV insertions, including one infant/preschool age
- At least 2 lumbar puncture with/without injection in preschool age/school age
- At least 1 manage occlusion in long-term access line*
- At least 3 nasogastric tubes in neonates/school age
- At least 1 nasopharyngeal swab
- At least 1 obtain EKG
- At least 3 phlebotomies
- At least 2 surfactant administration in neonate
- At least 1 throat swab
- At least 1 umbilical arterial line
- At least 2 umbilical venous line
- At least 2 urinary catheterization (1 in a boy; 1 in a girl)
Key Features
- This EPA focuses on the application of advanced communication and conflict resolution skills to address difficult situations that may involve patients, families, and/or members of the health care team.
- This EPA may be observed in any scenario that is emotionally charged. Examples include managing conflict (parent/physician; patient/physician; patient/parent; physician/health care professional), disclosing unexpected complications and/or medical errors, addressing non-adherence with treatment plan (e.g., vaccine refusal), and breaking bad news.
- This EPA does not include end-of-life discussions (TTP).
- This EPA includes documentation of the encounter.
- This EPA may be observed in a simulation setting.
Assessment Plan
- Direct observation by supervisor with review of documentation
Collect 5 observations of achievement
- At least 3 different types of communication
- At least 1 from each of setting
- At least 1 observation of a communication with an adolescent
- At least 4 different supervisor observers
Key Features
- This EPA builds on the skills of Foundations, adding patient care scenarios that are more complex (from a medical, social, psychosocial perspective) as well as transitions that may require coordination of multiple teams or professionals.
- This includes assessing the needs of the patient and family, orchestrating the team that will be involved in the patient’s care, making optimal use of community resources, providing handover to receiving physicians, and ensuring that patient’s family understands the current status of the patient health care needs and the management and follow-up plan.
- This EPA includes: inter-facility or intra-hospital transfer of a patient; movement of patients between health care professionals and/or settings, including admission from community setting, emergency department, different level of care within a hospital, and transfer of care from one practitioner to another; discharging a patient from an inpatient facility; and, transition of care to the adult setting.
Assessment Plan
- Direct observation and/or case review by supervisor, senior resident, nurse practitioner or other with expertise in transitions
Collect 4 observations of achievement
- At least 1 of each transition type
- At least 2 different observers
Key Features
- This EPA focuses on the efficient leadership of an inpatient service in the role of the senior resident.
- This includes organizing and delegating the daily workload for the medical team, working effectively with the interprofessional team, coordinating patient management and discharge plans and using available resources judiciously.
- At this stage, this EPA does not include the role of the most responsible physician for medical decisions.
- The observation of this EPA is not based on a single patient encounter, but rather on the resident performance over a period of at least one week.
Assessment Plan
- Direct and indirect observation by supervisor, of at least one week of clinical activity, with input from other team members and health professionals (nurse, clinical assistant, other health professionals, other residents or students)
Collect 2 observations
Key Features
- The observation of this EPA is based on completion of a scholarly project.
- This may include basic or clinical science related to pediatric medicine, advocacy, medical education, patient safety, QI, knowledge translation, and others at the discretion of the program director.
- This EPA includes reviewing and appraising relevant literature, using appropriate methods, analyzing findings, critically reflecting on the findings, discussing what the project has added to the field of inquiry, and disseminating results in some format (e.g., grand rounds, research day, manuscript suitable for journal submission) at the discretion of the program director.
- It includes preparation of an abstract, structured progress report, and/or manuscript.
Assessment Plan
- Research supervisor recommends achievement of the EPA to the competence committee
Collect 1 observation of achievement
Key Features
- The focus of this EPA is the role of the pediatrician as a teacher of junior learners, other residents, physicians, other health professionals and the public.
- This includes formal and informal teaching, as well as assessing and providing constructive feedback to junior learners.
- Examples of formal and informal teaching include: didactic sessions (e.g., grand rounds, academic half day, prepared teaching sessions with staff, formal undergraduate medical courses, small group formal session, large group formal session, conference presentation, community presentations), informal (i.e., impromptu) didactic sessions, physical examination skills teaching, procedural skills teaching and bedside teaching.
- The observation of this EPA is divided into two parts: providing teaching; and assessing and providing constructive feedback.
Assessment Plan
- Direct observation by physician or TTP resident, including feedback from learners if possible
Collect 4 observations of achievement
- A variety of teaching events
Key Features
- The focus of this EPA is the role of the pediatrician as a teacher of junior learners, other residents, physicians, other health professionals and the public.
- This includes formal and informal teaching, as well as assessing and providing constructive feedback to junior learners.
- Examples of formal and informal teaching include: didactic sessions (e.g., grand rounds, academic half day, prepared teaching sessions with staff, formal undergraduate medical courses, small group formal session, large group formal session, conference presentation, community presentations), informal (i.e., impromptu) didactic sessions, physical examination skills teaching, procedural skills teaching and bedside teaching.
- The observation of this EPA is divided into two parts: providing teaching; and assessing and providing constructive feedback.
Assessment Plan
- Direct observation by supervisor with input from the junior learner
Collect 2 observations of achievement
- At least 1 challenging situation